Monday, August 16, 2010

I've been thinking again about what we'll do about health insurance if we decide to have another baby. It's complicated, because we purchased an individual plan since we're self-employed, and the

Bill from 1972 for Wendy Diedrich's emergency room visit for 10 stitches with local anesthesia, with no insurance and a total (and out-of-pocket) cost of $16.60 for Wendy's parents (via flickr).

individual plans in the United States where I live don't have (yet) a lot of the safeguards group health insurance plans have (the kind you get through a "real" job). Health care reform's tantalizing protection against treating pregnancy as a pre-existing condition (with a nine-month waiting period, natch) won't go into effect for me until 2014, and we won't be waiting that long.

We chose our current health insurance plan by virtue of its being just about the cheapest our family of three could find. It has a big deductible ($6,000) and no maternity coverage, at all. So we pretty much just never use it, but it's there if we need it. Except, you know, if what we need it for is a pregnancy and birth.

So. Here are my options:

Upgrade our health insurance ahead of time to a plan that includes maternity coverage.

Pay out of pocket for all our prenatal, birth, and postpartum expenses.

Here's where I crunch actual numbers and hope that's not too crass. I know it's boring,

Bill from June 2010 for Bob Bobster's colon surgery and 6-day hospital stay, with a total of $43,651.05 in expenses, offset by insurance so Bob's out-of-pocket expenses were $1,500 (via flickr).

Even acknowledging, yes, different scenarios and allowing for inflation — holy moly, what a difference!

so you can skip ahead as you wish. I wanted to write it out for my own ruminating, but I decided to post it publicly in the hope it helps someone else going through the same calculations.

Our current plan (no maternity coverage) is $256/month for the three of us. It has a $6,000 family deductible, up to $300 a year (combined for all of us) in preventive care, and it's HSA eligible, so we can (theoretically) store money away pre-tax that can be used toward medical expenses. (I say "theoretically," because our most recent HSA money disappeared when it turned out the bank managers had been embezzling, but that's neither here nor there.)

PLAN A: If we upgraded with our current insurer, it would be $516/month for the cheapest plan that includes maternity. (At least they have a choice this time — last time I checked, they had had exactly one plan that offered maternity coverage. Now they have a whopping two.) That's a $9,000 family deductible at $3,000 per person, $30 copays for preventive care (including well-baby) visits, 30% coinsurance after deductible for all maternity care (prenatal, delivery, postpartum).

Definition break: If you don't shop for insurance a lot, a deductible is what you have to pay out of pocket before an insurance company will step in and pay out any benefits. Coinsurance is the percentage you have to pay of any expenses. So, if the coinsurance is 30% and the expense is 100, we pay $30 and the insurance company pays $70 — but only if our deductible has been met.

Website plug: I'm getting all these numbers at eHealthInsurance. I have no affiliation with them — I just shop for and buy my health insurance through them. (ETA: I just figured out I can have an affiliate relationship with them when I was on their site!) The prices are legally set, and the insurance company pays whatever fees might be involved for being in their lists, so there's no extra cost to the consumer. If you're self-employed, I highly recommend it as a site to shop health insurance plans and gather quotes, and then apply through the site electronically if the plan allows. It's easier that way.

PLAN B: If we moved to a different health insurance provider, we could get cheaper maternity coverage that would be in the realm of catastrophic coverage without technically being considered that. There's a plan for $385/month that has a monstrous $22,500 family deductible! No, seriously. Ignoring that one, there's a plan for $424/month that has a $15,000 family deductible. The point of these type of plans would be that they're there if anything really, really expensive went down, like an emergency C-section and a NICU stay. Otherwise, I'd be paying everything out of pocket. Preventive care is covered at 20% coinsurance with the deductible waived. Prenatal care is $25 each for the first four visits, then subject to deductible and 20% coinsurance. Labor, delivery, and hospital stay are 20% coinsurance after deductible.

Care providers: The midwives we used with Mikko, if someone didn't have insurance, offered a flat cash rate of about $2,000 that covered prenatal care (hour-long office visits), labor and delivery, and postpartum care, including lactation consulting and at least two home visits. I know — nice, right? They're not currently practicing (I shed tears just thinking of this), so I don't know if whatever midwives we go with (and we will be using midwives again if all goes well) will have the same sort of deal or a more expensive one, and how much more expensive.

Our medical plans for the next pregnancy and birth: We would like to have prenatal care but nothing too fancy. Last time, we had the most highly recommended tests and skipped the rest (including ultrasounds). We would like a home birth. However, we wanted a home birth last time, and we ended up transferring to a hospital for a non-medicated vaginal birth. I still have no idea how much that cost, because we had a different health insurance plan then with $0 deductible that covered maternity (the only one then available that did). If all goes as planned and we can use a midwifery care flat-rate plan, our expenses could remain under $3,000, including lab tests.
But, we all know things do not always go as planned, and if things went really pear-shaped, we could be out of pocket for tens of thousands of dollars in a flash. We are unfortunately (?) no longer poor enough to qualify for much or perhaps anything in the way of financial aid from a hospital, though I'm sure we could work out a long-term payment plan. That wouldn't be much consolation, though, if they took all our retirement savings and then some. According to WSHA Hospital Pricing, the average price in Washington State for a delivery is somewhere in the range of $8,193 for uncomplicated vaginal birth to $20,224 for a complicated cesarean. That doesn't include charges for the physicians, surgeons, or anesthesiologists, or any emergency ambulance service. I'm not sure if it includes any medications used before or after birth, and I believe the newborn's hospital stay is a separate charge.
I have considered an unassisted pregnancy and birth — but more so before Mikko's birth. There were some complications (excessive postpartum bleeding, for the most part) that made me appreciate having qualified attendants. I'm not judgmental against those who choose unassisted births, but I'm in a headspace where I'd rather have midwives present.

So here's a little chart breaking down the price difference between our current insurance, Plan A, and Plan B:

COST

Monthly

Yearly

Difference

Current Plan

$256

$3,072

—

Plan A

$516

$6,192

$3,120

Plan B

$424

$5,088

$2,016

So, if we upgrade, we're talking at least $2,000 more a year in insurance premiums. Plus, neither plan covers all of our increased health costs. In Plan A, we'd be paying all our prenatal care out of pocket and hit the deductible only if we had unforeseen expenses relating to prenatal care, the birth, or postpartum care. However, if we did hit a complication, it wouldn't be long till we hit the deductible, and then things would be covered at 70%. In Plan B, only four prenatal visits would be covered at $25 apiece, and even a vaginal hospital delivery would be out of pocket, with a $15,000 deductible. Only if there were more severe complications would the benefits kick in.

So: Is $2,016 with Plan B a fair price to pay for peace of mind in the event of any catastrophic complications? Is paying $3,120 more a year for Plan A better to have less out-of-pocket worry in the case of even mild complications (like my previous, non-emergency hospital transfer for a natural vaginal birth), when with an uncomplicated pregnancy and home birth under midwifery care, we could get away with paying over $1,000 less without upgrading? Remember that we're paying the cost of prenatal, birth, and postpartum care mostly out of pocket in all three cases if it's an uncomplicated pregnancy and home birth, and we'll say that's $2,000 since that's what our old midwives charged.

Here's another chart to illustrate the options:

MATERNITY CARE

No maternity coverage

Plan A

Plan B

Uncomplicated (annual cost)

$2,000

$5,120

$3,800 (taking off some for the first four prenatal visits being partially subsidized)

Complicated additional expenses (annual cost)

100% of costs (potentially $$$$$)

$3,000 deductible, then 30% of costs

$15,000, then 20% of costs

It's a risk-benefits game, but the potential losers are my baby and my health.

A couple other factors to keep in mind:

Every month I've upgraded to the higher price but don't get pregnant, I lose even more of the benefit of the higher-priced insurance. Ideally, I'd time it so my coverage kicks in the month before we conceive, but I can't guarantee anything like that. Note that this also doesn't allow for any spontaneity in our planning (no let's just go for it, honey! moments), as you can see from all the dull, dull, dull, deadly dull html tables.

Both Plan A and Plan B do not have the HSA option for paying medical expenses with pre-tax dollars. For instance, that $2,000 under our current plan would actually be $2,000 minus our tax bracket, so let's say $1,700. This is assuming no embezzling of HSA funds happens, again. Beyond that, our HSA money gets us this discount* on anything medical, including things our insurance doesn't cover, such as vision and dental care as well as prescription and over-the-counter medication. I'm just not sure how to factor this into the charts since I'm not sure what the yearly average HSA benefit is to us. (*I say "discount," but it's actually a more complicated process of getting a tax deduction after the fact. I guardedly recommend HSA-eligible plans to self-employed families who are willing to manage their own healthcare spending — just try to choose an HSA manager who's not a crook. Ha.)

Both Plan A and Plan B offer vision coverage, and our current scheme doesn't. However, an eye exam and some glasses every couple years is not worth so very much that I throw that into the consideration.

Philosophically speaking, assuming I've lost 90% of you with all these #%*$!@ numbers, why do I have to make decisions like this?

Why is my baby's health and my health dependent on some number-crunchers who decided pregnancy was too much of a financial risk for them to bother making maternity coverage standard or easily obtained?

Why is maternity care so expensive in this country, with the overzealous medicalization of prenatal care and childbirth?

And how does even an uncomplicated hospital birth cost over $8,000?

Does anyone think it's a teensy bit sexist not to cover a condition that half the people of childbearing age are subject to? (And you know which half I'm talking about.)

Knowing that I am extremely privileged to be having this decision to make, how do unemployed or self-employed people without the financial resources to purchase individual health insurance and no access to group health insurance afford to give birth?

I don't understand it, and I don't appreciate making decisions about expanding my family based on finances.

But there it is.

And this is not meant to be a political post, but I will say that I've gotten very offended when family members have talked about health care reform disparagingly, as if it's affecting those people. Nuh-uh. It's affecting me, and my partner and their grandchild(ren), their loved ones. This is an untenable situation for us to be put in, and I'm so conflicted about what sort of risk I'm willing to take vs. how much of my hard-earned money I want to hand over to the insurance companies.

So what would you do? Plan A, Plan B, or brave it without maternity coverage at all? Have you ever or would you ever consider forgoing insurance coverage for pregnancy and childbirth?

I wrote this last night as I was cogitating, and today I called the health insurance company just to confirm that, yes, pregnancy is a pre-existing condition on my plan, and it is. She did inform me of a few more facts:

For pre-existing conditions, they look back six months from the date of the new plan application for any medical diagnosis, care, or treatment.

Therefore, the "pregnancy" starts when I first seek medical care. According to that, I theoretically could buy the upgraded insurance at 8 months pregnant as long as I sought no prenatal care before then and that would be the first record that I had the condition. I'm not saying this is my plan, just that it's kind of ludicrous. I'm not sure how much to trust that, though, since I don't have it in writing. My concern was more specific: If pregnancy is dated from last menstrual period and my plan went into effect before conception but after LMP, is it covered? According to the woman on the phone, it would be.

If I get pregnant on my current plan and upgraded, she said prenatal care would be covered under the new plan immediately but not delivery. (Big whoop, I know, but at least it's something.)

I could upgrade just myself to an individual plan with maternity and leave the boys where they are, which would be $354/month for our family total. I know — more numbers. That actually sounds much more doable to me, but I have to look into the tax implications of that, because I thought we had to have a family plan to deduct the cost from our business taxes. It would be a blow to lose that. More thinking and researching to do!

The woman on the phone was very pleasant, but I'm still shaking. I'm thinking it must be rage.

Wow, am I ever so thankful to have given birth in two countries where maternity care is covered by the state 100%. In Ireland, most health care is paid for privately or covered by private health insurance, maternity care (and health care for the children, elderly and those living in poverty) is paid for by the state. And Canada has universal public health care.

A $20,000 deductible is ludicrous! Good luck with your decision-making. The numbers are a bit boggling.

hmmmm interesting stuff. We pay about 1/3 of my hubby's paycheck to our health insurance. We get it because we know if something awful were to happen it would be worth having. But it sucks to see that money go away. Having a baby is so darn expensive no matter what you do! Our daughter just turned a year and we still owe the hospital some money....one month at a time.

Not sure if this helpful but my mother in law (who's an accountant) said something about how if you're medical expenses are greater than a certain percentage of your gross income (I want to say 7% ?) you can write them off on your taxes, now I think you can either do that or FSA/HSA but not both, but I'm not sure...let me know if you need more info. And yes this situation IS appalling.

For our first birth, we planned a UC, but saved up the $5000 of our maternity deductible for an emergency transfer. We didn't need that $5000, so we used it to buy a car with 4 doors and air conditioning.

This more recent time, our deductible had gone up to $7500 and we moved out of state at 30 weeks. We erroneously thought that if there was no break in our coverage, we would be able to get insurance in our new state. No dice. That only applies to group policies, not individual ones. So we were denied insurance in our new state. We continued to pay our insurance in our previous state and just accepted the fact that if there's an emergency, then we'll have to pay extra for being out of area. Luckily, we haven't had such an emergency. In 3 months, we'll find out if my husband's internship becomes a permanent job and if we'll get insurance. We've decided to just keep up the out of state insurance for these last few months. I hope he gets the job. We'll be able to enjoy the luxuries of dental and no pre-existing conditions! It's been 4 years since I've seen a dentist (to the day, actually).

But I totally feel your pain. I wish we had gotten a health savings account when we married 4 years ago.

Those deductibles are absurd! But I absolutely disagree that the health care reform bill will do anything positive towards making good quality healthcare widely available to all American citizens. I think deregulating, like removing restrictions on sales across state lines, would do much more.

Ugh. What a rediculous system! For me, personally, it would be worth the peace of mind to have some kind of insurance, just in case something unexpected happens. Between the two plans, ugh, thats a hard one! I guess I'd lean towards Plan "A"? Though I would absolutely look more into just getting yourself covered, if it doesn't impact taxes.

Also with taxes, I'd look more into the thing about writing off expenses that are more than a certain percentage of your income, for sure! I know we have benefited from that in the past!!!

Hi- It's so crazy that we have to consider money in making our health care decisions for our families in this country! Personally, I'd lean towards Plan A- higher premium, lower deductible. I think $1,000 a year is worth it (even when I'm not making much money) for the peace of mind- especially since you had some mild complications the first time around. We pay over $900 a year for cell phone service for two people, 2000 for utilities, etc... to me 1K is a good price for peace of mind. I hope that you have the midwife tended at home birth you plan for, but things happen! If you go for the plan with the lower monthly cost, and the 15,000 deductible I think you'd be seriously kicking yourself if something happened! I might wait till I was actively trying to conceive to change my plan in any event! Good luck!

I have so much to say about this, but I'm not sure I can keep the numbers I want to add to this straight right now.

First, we're in the same boat. Self-insured, high deductible, thinking about maybe having another kid. Our plan offers a maternity rider for about $100 more per month, with a 6 months pre-existing period. I actually have to have a documented negative pregnancy test in order to qualify for the rider. (I also had planned a home birth but wound up with a hospital transfer with my son.)

The political aspect of this - it's complete BS that maternity has separate coverage. It's also BS that women pay higher premiums than men in employer sponsored plans that don't carve out maternity. Quality pre-natal care benefits everyone. Not just those with a uterus.

Get some kind of coverage. Even if it's a plan with a higher (I think $20k should be in the column marked "useless"), so you can take advantage of any contractual reduction your carrier has negotiated with a hospital. (For instance, my hospital stay was BILLED at about $22k - which was for my stay, and the baby's stay - including medications, but not including the obstetrician, pediatrician, and anesthesiologist. My insurance company only ALLOWED $10,000. And at the time I had a 50% maternity coverage plan, so we paid $5,000.) If you don't have insurance you could be on the hook for the full BILLED amount. (Billed versus allowed is very important in insurance.)

The cost of the doctors is pretty negligible, when compared to the hospital. So IMO, you're (and maybe I'm) looking for coverage that's not going to force me (I hate the privilege that's about to come out of my mouth, errr, fingers) to eat potatoes and bread to cover the premiums, and won't force me to sell me house to cover the deductible in the event that I find myself in the hospital again.

Very frustrating. When a surprise baby #2 came along I had no maternity health care and did not qualify for California's Medi-Cal program for pregnant women because my hubby made too much money. Also, I did not qualify for new maternity coverage because every time I tried to apply I was denied because pregnancy is a pre-existing condition. Thankfully an operator with Kaiser HMO told me about California's AIM program. Basically it is a program in place for middle income women who do not have maternity coverage. I applied and was accepted. My cost was a % of our income, a very small percentage thankfully. In the end I only paid $1,100 for my entire pregnancy and 6 weeks postpartum and had a year to pay it off. We planned a UC anyways, but it was good knowing we had coverage, which did come in handy last minute when a complication arose.

It sounds like you have only been looking at high deductible plans. Have you considered an HMO or fee-for-service plan? On the down side I think those are more expensive, on the up side if you know that you are likely to be a health care consumer for a year, it might be worth it for the extra coverage.

i don't have personal experience with this, but a good friend of mine just went through pregnancy & birth without insurance.

first of all, our local birthing center allows moms-to-be to prepay for their entire labor & delivery, which is somewhere around $5 or $6K, so she opted for that. she had to be taken to the hospital mid-labor, however, for an emergency c-section. her $30K bill was covered by medicaid when she applied AFTER she had the baby (they cover any medical costs three months prior to qualifying). she & her husband qualified because they then had a child, which makes it very easy to get coverage, unless you make lots & lots o' money, in which case you'd probably have been paying for health insurance in the first place.

my husband & i have decided to follow this route. we're putting away monthly what we would otherwise be spending on our premium - which was close to $400 a month! - which we may or may not need for future health care. i'd rather pay medical bills out of pocket in smaller monthly chunks than give $400 a month to an insurance company that will only cover my maternity after FIVE YEARS of collecting my money. (what?!)

this plan is not for the weak-at-heart, but we've decided that it works best for us.

I've had 2 home births. For the first, we did not have health insurance and the state we lived in did not license midwives anyway, so we paid $2600 out of pocket. We had insurance the second time (Tricare, if you care) and the state we lived in that time did license midwives. We paid $5000 out of pocket and hoped that insurance would pay as back a little. To our surprise, they wrote us a check for $3200 a couple months after the birth.

I did apply for Medicaid for my first birth in case I transferred to a hospital but I did not need it. The Medicaid income requirements are actually pretty high.

I'll be honest and say I skipped over most of the post because I didn't understand it! I've always worked full-time out of the home and have always participated in group insurance plans. That said, with my first pregnancy I was considering going over to a midwife and asked her if she took my insurance. She said she did, but her total bill for every pre-natal visit and attending to my birth, plus post-partum visits would have only been $3,000. That seems really cheap in my opinion. Can you contact local midwives and see what they charge? I think skipping insurance is a risk only you know if you can take. I've always been extremely healthy, rarely get sick and my first pregnancy was textbook, really easy, my birth was easy and fast. So if I had to, I'd feel comfortable skipping the coverage and just paying a midwife out of pocket for a home birth or birth center birth.

I don't have time to read the entire post or comments, but I'll toss out an idea. We haven't had insurance for 4+ years because I couldn't get it thru work and we found the $250/month and $3k deductibles too costly for us.

So, when I got pregnant, we paid out of pocket for our midwife's services ($2K). We were, however surprised to find out I qualified for medicaid in our state for the pregnancy and birth, and for our daughter during her first year. And she still qualifies with after a year, we just pay $22/month for her.

We adults still don't qualify for Medicaid, but you might be surprised to find your state, like ours, does at least try to take care of infants and children.

We have insurance only on me that maternity wise covers only catastrophic complications of childbirth. We have it mostly in case we have a premie or some other emergency.

We had both of our births with a CPM and paid $1000 for each of them, out of pocket. We considered it a bargain since the local hospital charges around $10,000 for an uncomplicated vaginal birth.

Our insurance premiums keep going up, though, and it covers so few things that I never use it. Since we are conservative Christians, we are looking into a Christian medical sharing program where you agree to help pay others needs and if you have needs they will help you. One thing that really appeals to me is that on most things they won't share the need until you go above a certain amount... but that is waived if you have a homebirth with a midwife because that is so much less that they're willing to pay all of it. Since we paid completely out of pocket for our two births, I am very excited about it.

It's great to have all your input, even if I'm jealous of those of you with public health insurance! The idea of saving up in advance is a good one, although of course even that wouldn't end up paying for severe complications. It's so frustrating.

Yuliya: You're right, and I'll keep that deduction in mind if our expenses get that high. We don't usually owe much in personal taxes (just lots and lots of business taxes), so I'm not sure what sort of effect that would have.

TopHat: Aren't those rules the worst? I'm dismayed that portability laws don't apply to individual policies. Fortunately, they will under HCR, not that that does any good retroactively. Sam & I haven't been to a dentist in years, either; we've never had dental insurance.

Maman: To avoid getting into a political fight, I'll just say that one implication I've heard from my more conservative relatives is "If people don't have insurance, they should just get a real job." I think we can agree that's offensive and unhelpful and coming from a place of unthinking privilege.

TMae: I looked into a rider, but ours doesn't have it. Interesting that you had to have a negative pg test! See, I hope the person on the phone with me wasn't misinformed about in what ways pregnancy can be considered a pre-existing condition. And totally agree with you on the fact that quality prenatal care benefits everyone; I seriously can't believe it's legal to discriminate like that. Good point about the billed vs. allowed; I'm always surprised by the statement of benefits that shows how everything was discounted. I know we were able to get some discounts and freebies from our dentist since we don't have dental insurance, but I can't count on that with a hospital or doctor. Re: the privilege thing. I know. Even writing this post, I feel like a whiny little middle-class person. In my sort-of defense, I will just say that there are programs in place to take care of lower-income families, and higher-income can afford to pay, but people stuck in the middle are…well, stuck. Even if I make too much to qualify for Medicaid, it doesn't mean a hospital bill couldn't bankrupt me. And then I'd qualify for Medicaid — woot!

Tamara: Mamamilkers told me about First Steps, which is a similar program for maternity and child insurance in Washington state.

Natalie: I've heard of the health share groups. I should see if there's one near us. Thanks for the reminder. I like the community aspect of that.

A note about financial assistance programs and why I ruled them out for us: The first time I was pregnant, I applied to ~3 low-income programs, but I was turned down. It's another way self-employed people are penalized. According to their online income charts, I should have qualified, but when I went through the process, it turns out they calculate self-employed income differently. They look at gross business income first and then don't allow as many deductions as the IRS. I think maybe having a retail business hurt us the most, because gross receipts for retail are so much higher than net; if we had a service business, our gross and net would be closer in amount. Then, for instance, they wouldn't allow us to deduct equipment we'd bought for our business. They wouldn't allow a mileage deduction because, and I quote, "You work from home, so you don't need to drive anywhere." Um, yeah. We drive to the post office and UPS store nearly every day.

Talking to the financial assistance people was humiliating. They were really condescending when they thought I was poor. When they decided I was too rich, they were scornful and made me feel like I was stealing food from deserving people. If we don't qualify for assistance, then I don't want to sneak in and try to get it, but I think it's valid to apply and find out, don't you? So I gave up and just felt bad for anyone who had to deal with them on a regular basis. Maybe I just got employees who were having an off day, though. I can imagine there's a lot of stress in that job.

At the same time we didn't qualify for the state programs, the hospital where Mikko had surgery did qualify us for their private financial aid, which they based off our adjusted gross income rather than our schedule C income. You know, the rational way.

Oh, a note about saving up in advance: The state programs also penalized us for having money in savings. Go figure. We should have been less responsible. Stupid us.

Now, we'll have four people in our family instead of just three, but I don't know that we'd still qualify for any sort of state aid. But, anyway, I'm glad it's in place for those who are able to use it.

Unless you make more money now than when you were pregnant with Mikko, you might just qualify when you are pregnant again. Worth checking anyway. I know it may be annoying to deal with those people, but also might be worth it in the long run.

I'd just go with a midwife and pay out of pocket. If there is an emergency, and you end up with $20,000 in medical debt...well...that's not the end of the world. Payment plans! If you tell them you can pay $10 a month, and pay that $10 on time every month, they can't call you excessively or send you to creditors.

I have no suggestions, because even though I am actually a lover of numbers, I find all of this entirely too upsetting. I can't even begin to understand why so many Americans oppose universal health care. I can't even begin to conceive of the very IDEA of a 'pre-existing' condition. And that pregnancy and maternity care would not be covered? Outrageous!

I am Canadian, and so the idea that I would have to pay for necessary health care is foreign to me. I can only say that I hope that my American friends can one day seek necessary medical care without having to consider whether or not they can afford it. As someone who has always enjoyed this amazing privilege, it feels like such a no-brainer.

I agree with the suggestion to check into state insurance. I had it as a supplement to my regular insurance for 2 of my 3 pregnancies and didn't pay a dime for either. The income levels for getting that insurance (at least in MN) are much much much higher for pregnant women than anyone else.

If that doesn't work, I'd throw plan B out all together. Either fork out the extra premium for some real piece-of-mind coverage or pray for the best and go it alone. The in-between plan doesn't seem to make much sense to me.

Have you considered calling the hospital and asking them if they have a discount for patients who do not have maternity insurance? Many hospitals will do this, especially if you are going to pay in cash and can pay some portion of it upon arrival. Are there any birth centers close to where you live? They might would charge less than the hospital. Also, with the hospital, make sure to get an itemized bill (I'm sure you know that.) Our bill charged us for an epidural (which I did NOT have) and charged us for the Vitamin K shot, erythromycin drops, and heel stick for The Cute One (and he did NOT have ANY of those.) When we made them aware of it, they removed the charges and that helped out on our end with the bill.

The other thing to consider is that your hospital transfer was because of something that technically might could have been discovered at home. Not ragging on your midwives at all, but it wasn't something like Mikko suddenly had fetal distress and it was a mad dash to the hospital.

If we *ever* have another baby, I would like to do a waterbirth at home. We had a great hospital experience with The Cute One, but water would have helped my back labor tremendously, and our hospital didn't have tubs, just showers. It will also save us a ton of money, and we have maternity insurance.

If you go to hisboyscanswim.com, they have a page at the top of their blog about what they had to pay for their baby, because, like you, they buy their own health insurance, and they didn't have maternity coverage when they got pregnant.

Personally, I would switch plans to either A or B (depending on whether the 15,000 vs 3,000 is a bigger deal than the 20% vs 30%), and I would make sure the new little one was covered on the new plan. Because honestly, the idea of being put in a place where you have to weigh your health or your child's health against money is chilling. Our system stinks, but at least the other plans give you a better chance if something goes wrong.

I say that, of course, as a mother of one little boy who was a vaginal delivery but required what amounted to major surgery (per the OB) to repair me afterward, as well as an extra day's stay in the hospital, antibiotics, a surgery at 5 days old, and a year of physical therapy. (He's fine now.) Luckily, we were insured through my work, and the cost was not too bad; without insurance covering it, it would have been another matter entirely.

Not that I could have made any choices but the ones I did, but they would have been harder to face down.

I don't have any practical advise, but doesn't it suck? With our little guy, we just had to decide when he was born that we'd have to do everything we can to keep at least one "real" job at all times, even if its not the best for money/career because individual coverage isn't an option and those state high-risk pools are a joke.Anyway, I'd say maybe do the high deductible thing just in case and then the HB MW are probably the best deal. I think they charge about $3000 for everything here in CO. It would be nice if the powers that be would recognize what a cost saving investment this is and then we probably could give care to everyone without braking the bank... anyways, tangent.

@lauren - hobo mama.i planning to start TTC next summer, so i'm investigating all my options now. i am a full-time nanny and i don't have any health insurance presently. even though i'm paid partially on the books and partially off (so my declared, provable income isn't that much), i still make too much to qualify for free healthcare from the state of ny! of course, once i'm actually pregnant, that changes and it may at least be more affordable, if not free, but SHEEEESH! that being said, i want to have a home birth w/midwife, so i called around and the response i got from one midwifery center was: WITH insurance it's $10,000 for pre-natal, labor/delivery, & 2 post-partum visits. WITHOUT insurance, they put that on a sliding scale of...$7,500. not quite the discount i was hoping for. i guess EVERYTHING is just more expensive in ny...i envy your $3,000 home birthing in washington state...*sigh**shirelle.

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Riding the rails with my husband, Crackerdog Sam, and our hobo kids, Mikko Lint Picker (born June 2007), Alrik Irontrousers (born May 2011), and Karsten (born October 2014). Trying every day to parent intentionally and with grace.